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ications and higher perioperative mortality and worse long- term outcome. Symptomatic, high shunt CAF must be interrupted. The presence of daily ischemic symptoms in our case report patient, is worth to be remarked. Alternatives for fistulae closure are transcatheter or surgery, depending on anatomic variables and the presence of associated cardiac conditions. Surgical epicardial closure of LAD to PA fistulae variant can be done with very low mortality and morbidity, but other variants with coronary aneurysm, drainage in the coronar
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